Neurological Disorders and Neurofluids
摘要
This chapter reviews a broad class of neurological disorders linked to disturbed fluid dynamics, specifically the interactions of neurofluids, including arterial and venous blood, cerebrospinal fluid, interstitial fluid, and lymph. Cerebral venous outflow strictures, both intracranial and extracranial, are identified as major triggering mechanisms for CNS pathological states. The head and neck venous system is examined, building on the related anatomy and fluid physiology covered in previous chapters. Jugular and extra-jugular venous districts, as well as physiological cerebral venous outflow patterns, are explored. Multiple sclerosis is reviewed in light of the currently dominant autoimmune theory and the re-emerging vascular theory, which historically assigned a prominent role to the cerebral venous system. Also examined are retinal abnormalities, transient monocular blindness, transient global amnesia, Ménière’s disease, idiopathic intracranial hypertension, idiopathic Parkinson’s disease, and Alzheimer’s disease. Two methods for restoring normal, or nearly normal, cerebral venous outflow are discussed: Percutaneous Transluminal Angioplasty (PTA) and dedicated venous stents. Studies on the application of these methods to patients with anomalous cerebral venous outflow have shown that restoration of venous flow, close to physiological conditions, has a net positive effect on selected patient groups. However, due to re-stenosis, PTA must be excluded as a viable therapy. Dedicated venous stents appear promising but still need to prove their long-term effectiveness. Much research is still required to elucidate the underlying mechanisms and design effective therapeutic strategies. We advocate for a comprehensive, multidisciplinary, and holistic approach, one that involves the interactive dynamics of all neurofluids, in which mathematical modeling and simulation can play a significant role.